In many countries, nurses and midwives receive their basic education at university level. While some countries show a trend towards university education for all, others tend to educate a small core of professional nurses and a large number of auxiliary personnel. The move to higher education is therefore subject to various interpretations; in view of the wide differences in local circumstances and needs, educational systems, available resources and other factors, it is difficult to design an educa-tional model that would be appropriate or feasible everywhere. In some cases, training is wholly vocational, controlled by the health sector and takes place in schools of nursing attached or affiliated to hospitals. In others, it may be controlled by and take place in institutions of higher education.
In some CCEE, the former Czechoslovakia, Hungary and Poland, university courses for nurses have been established for many years. Oth-er countries have recently established opportunities for highOth-er educa-tion, such as Albania and Slovenia, or are in the planning phase, such as Bulgaria.
University education became available to nurses in Czechoslovakia
in 1960. Entry requirements include graduation from a secondary
school of nursing, preferably with nursing experience. The studies are interdisciplinary and involve the faculties of philosophy and medicine;the former is responsible for the education of teachers. The nursing cur-riculum includes psychology and pedagogy. A full -time nursing pro-gramme (a five -year Master of Nursing propro-gramme and a three -year Bachelor's programme) has been available since 1980. Academic qual-ification is by thesis and state examination. The programmes are de-signed mainly for nurse managers and teachers, but offer opportunities for those without previous experience. A few nurses study for doctor-ates.
In Poland, university nursing education started in 1966 at Lublin.
There are now five programmes in the medical academies, and
gradu-ates from these courses comprise 1.5% of nurses. The holder of a Mas-ter's degree in nursing has equivalent legal status to other professionals with higher education. It is hoped that this will become an essential qualification for nurse managers and teachers. Four medical academies offer degree courses to qualified nurses; the 4 -year programmes can be reduced to 2'/2 years if the nurse has already taken the teacher training course.
In Slovenia, university education opportunities for nurses began in 1993 at the University of Ljubljana, with a Bachelor's programme in health education. A new nursing degree course is being established in Maribor with the support of the WHO collaborating centre for nursing.
In Croatia, education is being reformed and nurses are pushing for an academic nursing programme to include the degrees of Bachelor of Sci-ence in nursing or PHC, a Master's degree and a doctorate in nursing.
Some nurses have degrees in psychology or pedagogy and a few have obtained a Master's degree in public health or social psychology.
In the NIS, only Estonia, Kazakstan, Lithuania and the Russian Fed-eration have recently established university nursing courses offering a Bachelor's or Master's degree. There are no such opportunities else-where, although countries such as Belarus and Latvia are planning to introduce university training. In Lithuania, a faculty of nursing was established at Kaunas Medical Academy in 1990. It admits qualified nurs-es with two years' clinical experience who pass the university entrance examination. The programme lasts 372 years; graduates are expected to become leaders in government, teaching, management and clinical prac-tice. There are no nurses on the faculty staff and the curriculum does not meet international standards, but good progress is being made. There is a shortage of adequate specialist teachers. In Estonia, nurses have been admitted to Tartu University since 1991. They must have 12 years' gen-eral education, 3 years' nursing education and 2 years' practical experi-ence. The first cohort of 20 students graduated in 1994.
In the Russian Federation, a National Council for Higher Nursing Education was established in 1993. In 1995, the first class graduated from the innovative programme at the I.M. Sechenov Medical Academy, Moscow, which offers a full -time degree programme for qualified nurs-es. The four -year course includes nursing, biological sciences, education methods and some practical experience; general subjects are included to fulfil university requirements. The intention is to prepare nurses for future leadership positions in practice, management and education. In addition, the Medical Academy has started evening courses in manage-ment and education. In Kazakstan, the Almaty Medical- Nursing College
has begun a new programme of advanced nursing studies. The pro-gramme had 250 students in September 1992, and is intended to enable students to take an additional third year to acquire a Bachelor's degree and a fourth year for a Master's. The curriculum has been revised to abolish non -health subjects, provide more care and practical skills, and offer tuition in the English language.
Nursing education is available at the university level in most west-ern European countries. In countries such as Germany, Greece, Malta and Spain, the opportunity for nurses to obtain a Bachelor's or Master's degree, or Ph.D. in their professional field is a very recent development.
In Austria and Switzerland, however, nursing studies are rarely or never taught at university level; nurses who wish to study at a higher level must major in an allied subject and take nursing as a minor subject. En-try requirements to university courses vary; in countries such as Bel-gium, only registered nurses can attend university, while education at university level is open to suitably qualified secondary school leavers and other health care professions in Iceland, the Netherlands, Portugal, Spain and the United Kingdom.
Nursing faculties in universities are usually financed by the ministry responsible for education or science, or its equivalent, as part of the na-tional education infrastructure. Exceptions include Spain, which has a complex public - private mix in ownership of the 98 nursing faculties; 26 belong to the Ministry of Education and Science, 58 to different public institutions, 10 to private institutions and 4 to private universities.
RESEARCHS
In all areas of health care, policy and practice are strengthened by the knowledge and evidence acquired systematically through research. Al-though awareness of the importance of research in nursing has grown
throughout the latter half of this century, the amount of substantive
research undertaken by the profession throughout Europe remains limit-ed. Where research findings are available, they are not always effectively disseminated and used.The crucial importance of research becomes ever more apparent as
the value and cost -effectiveness of nursing come under increased
' This section was written with the assistance of Alison Tierney.
scrutiny in this era of universal health care reform and cost containment.
Nationally and internationally, policy -makers, managers and practition-ers are grappling with tighter health care budgets, the rationalization of management, decentralization of services from hospitals to PHC, in-creased accountability to patients or clients, and new health problems and challenges.
The outcomes of health care result from many contributing factors, including individual, cultural, socioeconomic and environmental factors that interact in complex ways. The task for nursing research is:
to tease out the impact of the nursing contribution to health care;
to demonstrate the value and cost -effectiveness of nursing practices and policies; and
to ensure that the care that nurses provide in any setting is firmly based on the best available knowledge and evidence.
Nursing research has been established and is growing, even if slow-ly, throughout the European Region. In some countries, mainly those with stronger economies and a tradition of scientific endeavour, the nursing profession has steadily amassed, over the past 30 years, exper-tise and financial support for the development of nursing research. The United Kingdom and some of the Scandinavian countries, for example, now have a sizeable cadre of trained and experienced nurse researchers, a considerable amount of research activity as reflected in published out-put, increasing success in securing funds for nursing research, and ex-plicit nursing research strategies at the national level.
In 1993, the United Kingdom became the first European country to produce a government- supported national strategy for research in nurs-ing and midwifery. This strategy is an integral part of an overall strategy for research and development for the NHS as a whole: the government devotes considerable funding to the implementation of these strategies.
The aim of this ambitious scheme is to promote evidence -based practice in all the health care professions, and to encourage collaboration among academic researchers of all disciplines and between researchers and the providers and purchasers of health care. The introduction of information systems is strongly emphasized to ensure that research findings are dis-seminated effectively to practitioners.
Of course, compared with many other countries in the Region, the United Kingdom has economic advantages, the benefits of political sta-bility and a long tradition of scientific endeavour. Even so, research in nursing grew slowly and with little initial financial support. The most
crucial positive influence was the gradual change in attitude of British nurses during the 1970s and 1980s, as nursing education began to em-phasize the importance of critical thinking, and as nurses in practice took more innovative, reflective and evaluative approaches. Such atti-tudes and approaches can be developed throughout the Region, even when the profession faces a lack of infrastructure, scientific expertise or funds.